Provider Demographics
NPI:1467741611
Name:ZIMM, MEGAN E
Entity Type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:E
Last Name:ZIMM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SUTTON
Mailing Address - State:WV
Mailing Address - Zip Code:26601-1308
Mailing Address - Country:US
Mailing Address - Phone:304-765-2562
Mailing Address - Fax:
Practice Address - Street 1:168 MAIN ST
Practice Address - Street 2:
Practice Address - City:SUTTON
Practice Address - State:WV
Practice Address - Zip Code:26601-1308
Practice Address - Country:US
Practice Address - Phone:304-765-2562
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-28
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0007145183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist